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HomeMy WebLinkAboutS&S Concrete 4-23-19 AC $ CERTIFICATE OF LIABILITY INSURANCE DA `M"�°°"""'03/26/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: JIM MITCHELL INSURANCE AGENCY PHOttE EAL 920-233-0272 FAXX No): 920-233-2712 1924 S.WASHBURN ST. ASS: OSHKOSH,WI 54904 INSURER(S)AFFORDING COVERAGE NAIC at INsuRERA: SOCIETY INSURANCE COMPANY INSURED INSURER B: S&S CONCRETE,INC. INSURER c 313 ALLEN AVE. INSURER D: OSHKOSH,WI.54901 wsuRERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSDL POLIUERCY POLICY NUMBER IMNIDOIYYYYI (MSYDOIYYYY) ITS XCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE 1><1 OCCUR DAMAGE TO RENTED PREMISES 000 PREMISES(Ea occurrence) S MED EXP(Any one person) S 5.000 A BP17003725 04/23/2018 04/23/2019 pERsoNAL&Am(INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY LJ JF Q LOC PRODUCTS-COMPIOP AGG $ 2,000,000 I OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S A ALL O D `/ SCHEDULED CA17003725 04/23/2018 04/23/2019 BODILY INJURY(Per accident) $ AUTOS +(�, OS NON-OWNED PROPERTY DAMAGE HIRED AUTOS i AUTOS (Per accident) S UMBRELLA UAB _- OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABLITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED I N/A E.L.EACH ACCIDENT S (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S H yes,desaihe under DESCRIPTION OF OPERATIONS below E.L-DISEASE-POUCY UMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,rosy he attached Y more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH AVE OSHKOSH,WI 54901 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD